LTC Staffing ratios?

VANurse2010 · Nov 13, 2012

Here's a tip: There are no minimum staffing policies in any state for LTC. The only policies are that there must be x number of nurse hours for x number of residents, but there's nothing that says an aide can't have 25 or a nurse can't have 50.

NamasteNurse, BSN, RN · Nov 14, 2012

as VANurse says there are no legal staffing ratios! Crazy huh? Your staffing is normal. We have 40 residents on our floor and most good days we have two nurses and 4 aides. Most evenings they have 1 nurse and three aides! Horrible. I hear ya about providing good care, most days we provided the minimum and hope for the best. When you have a heart, it hurts. I have unfortunately learned that you have to shut off part of your emotions in order to get all of the necessary work done.

phillips3384 · Nov 14, 2012

Actually in Oregon there are staffing ratios for CNA'S. It is a 1:7 for day shift, 1:11 for eve shift, and 1:18 for NOC shift. It has made life so much better for LTC resident's.

phillips3384 · Nov 14, 2012

Oh......Oregon also requires that you post how many CNAS, RNs, LPNs, etc in the building, as well as, the current census. The charge nurse then signs it. When the state surveyors come into the building they look for that and if it's not there you get cited. So I think Oregon is on the ball staffing ratios.

MichelleRN34, ADN, RN · Nov 14, 2012

Hey all! I am an aide at a 64 bed LTC facility in the midwest. We are severely understaffed -- and have been for quite some time. The majority of the aides have one foot out the door and are looking for work elsewhere. Today I worked what is supposed to be a two-aide floor with 18-residents by myself (on day shift), and this is not unusual. You can imagine what happens to patient care... I am a good aide and do my best but I know for a fact that my residents did not get the time, attention, or care that they deserve. It makes me sick to know that we are taking care of human beings, but our admin cares more about the dollar signs than they do about getting more help (they refuse to hire temps, but they do pay "premiums" for when we work short -- I suppose I should be happy about that extra .50 an hour I was paid today).
So my question is this: Where do I go to find state policies about LTC staffing ratios? I didn't see anything on my BON website. Maybe I'm typing in the wrong google terms, but I didn't find anything there either. Any advice?

I once worked a snf that had 25:1 in day and 50:1 at night...it was crazy...that's why I left. I can't safely care for that many people. Especially when 1/4 of them are acutely sick.

phillips3384 · Nov 16, 2012

All I can say is come to Oregon. The ratios their are safe and manageable.

IowaKaren · Nov 16, 2012

I sure wish all states would adopt the staffing ratios the Oregan does. Otherwise, it's just a suggested ratio. We've been told that LTC's are now the 'mini hospitals' and Assisted Living is what NH's used to be. Hmmm, a mini hospital with post surgical residents, high acuity, and bariatric residents with many many issues and 1 nurse to 25-35 residents with total dependent needs and maybe 1 to 2 CNA's to assist with those needs (depending on the shift). If your lucky, you may get a CMA as one of those CNA's to possibly help with simple treatments. Every day it gets harder and harder to do a complete a thorough job that is required of you in the time constraints along with being the everything to everyone person also. And if you want to make the money you should make, you have to forfeit benefits (vacation days, holiday pay, insurance) to just make a decent paycheck. It's funny, they say we are staffed well but if you look at the Medicare Survey website, only 2 of 5 stars are given which is under the state's suggested staffing ratio's. Doesn't help when your in an area that is saturated with new nurses and the constant orienting of new nurses,... Not that new nurses aren't an assest, it does take time to learn all that is required of a nurse with more and more responsibilities dumped on daily, thus more responsibility on the other nurse (if you do have two nurses a shift) to keep ahead of everything.

MichelleRN34, ADN, RN · Nov 17, 2012

My new job is different. The most patients one nurse will have is 22 because its a 22 bed unit.

WanderingSagehen · Nov 17, 2012

25:1 nurse and 50:1 that sounds like numbers my facility is shooting for. It is definitely impossible to give quality care and families really don't understand this and should be fighting for their loved ones right to a dignified end of life. It is so sad that it is the staff who is providing this sub standard care is taking the brunt and not the facilities, management and CEO's and owners. This is just a terrible American tragedy. I think most SNF and LTC staff would love to provide better care. Most of us don't get true lunches or breaks except the smokers of course- but that's a whole other topic.

cienurse · Nov 29, 2012

Even though there are no minimum requirements by the State, I still got a deficiency for staffing last year because the surveyor felt I didn't have enough staff. Even when I was able to prove that I had no negative outcomes likes falls, pressure ulcers, and weight loss, they still tagged me based on their own opinion. And I will tell you that I had 2 nurses and 3 CNAs for 30 residents on days, 1 nurse and 3 CNAs on 3-11, and 1 nurse and 2 aides on nights-all of which they felt was inadequate staffing. I can't imagine what they would think of the staffing that's going on at the OP's place!

CapeCodMermaid, RN · Nov 30, 2012

In Massachusetts we have to post our staff numbers daily and we have no mandated patient to nurse or patient to CNA ratios.

My building runs on days for a 46 bed unit, 3 nurses, a nurse manager and 6 CNAs. Evenings 2 nurses and 5 CNAs. Nights...one and two. That's a long term unit. The short term unit has 2 nurses on 11-7. Families can complain all they want. Until what we do in LTC is valued by Medicaid, we will never have enough $$ to staff at the levels we'd like.